Member Application

Thank you for joining the Gay and Lesbian Chamber of Commerce Gulf South. Please complete the form below.

Business Information

Company Name:
*

Leave Blank:

Phone:
*

Website:

Email:
*

Business Description (200 char max):

Directory Category:

Employees:

Full-timePart-time

Business Keywords (enter a space between words):

Comments / Questions:

Referred by:

Physical Address

Line 1:
*

Line 2:

City:
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State:
*

Postal Code:
*

Country:
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Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Primary Contact Information

First Name:
*

Last Name:
*

Title:

Phone:

Cell Phone:

Fax:

Email:
*

Contact Preference:

EmailPhone

Login:

Password:

Social Networking:

LinkedInFacebook

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Billing Contact Information

Same as Primary Contact

First Name:

Last Name:

Title:

Phone:

Cell Phone:

Fax:

Email:

Contact Preference:

EmailPhone

Login:

Password:

Social Networking:

LinkedInFacebook

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package:
*

Student:
$25.00 Membership for high school and college studentsIndividual/Non Profit:
$100.00 Membership for non-business-owner freelance workers, employees, or those in employment transition. Also for Non Profit partners.Small Business:
$200.00 Membership for companies with 1-20 employees.Medium Business:
$400.00 Membership for companies with 21-100 employees.Large Business:
$800.00 Membership for companies with 101+ employees.Silver Corporate Sponsorship:
$1,000.00 Customizable online business directory profile, recognition as a sponsor at all chamber events, logo on homepage, logo in newsletter, discounted job postings on website, opportunities to post coupons or discounts on your products or services. Gold Corporate Sponsorship:
$2,500.00 Customizable Online Business Directory Profile, Recognition as a sponsor at all chamber events, Logo on homepage, Logo in newsletter,
Discounted job postings on website,
Opportunities to post coupons or discounts on your products or services. Co-Host one bi-monthly lunch and learn at no costs, with opportunity.Platinum Corporate Sponsorship:
$4,000.00 Customizable online business directory profile, recognition as a sponsor at all chamber events, logo on homepage, logo in newsletter, discounted job postings on website, opportunities to post coupons or discounts on your products or services, table setup at quarterly chamber events. Co-Host, at no additional cost, bi-monthly Networking Event (every other third-Thursday). One member of our Board will provide company-wide, on-site diversity training.